Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Severe Pain is Associated with Critical Illness and Mortality in Hospitalised Patients Across Africa: A Point Prevalence Study of 22 African Nations
Background: Pain in hospitalised patients is common and associated with secondary complications. There is little literature describing the prevalence and severity of pain in unselected samples of hospitalised patients across Africa. The relationships between pain severity and critical illness and mortality are unknown.
Methods: This international prospective point-prevalence study in acute hospitals across Africa included all inpatients ≥18 years old. On a single day, investigators assessed patients’ worst pain in the preceding 24 hours on a 0 – 10 visual-numerical scale and vital signs. Severe pain was classified as pain ≥7/10. Patients were classified as critically ill if ≥1 vital sign(s) was out of range, according to predefined definitions. Mortality was assessed seven days later. Data are presented as mean (±SD), median [IQR], n (%) and odds ratios with 95% confidence intervals.
Findings: We included 19 438 patients from 180 hospitals across 22 African countries and territories between September and December 2023. The median [IQR] age was 40 [29; 59] years, and 10 874/19 429 (56%) patients were female. The median [IQR] pain severity was 3 [0; 5], and 2 795/19 438 (14·4%) reported severe pain. Risk-adjusted multivariable regression models showed that severe pain was independently associated with critical illness (p < 0·001) and with seven-day mortality (p = 0·020).
Interpretation: One in seven hospitalised patients across Africa reports severe acute pain. Severe pain is associated with both critical illness and mortality. Resources should be directed to effective and feasible strategies to manage acute pain and potentially impact clinical outcomes.
Keywords: Pain, Critical Care, Critical illness, Africa, Global Health, mortality, Epidemiology, Patient
Bedwell, Gillian J. and Parker, Romy and Madden, Victoria J. and Scribante, Juan and Elhadi, Muhammed and Ademuyiwa, Adesoji O. and Osinaike, Babatunde and Owoo, Christian and Sottie, Daniel and Khalid, Karima and Hewitt-Smith, Adam and Kwizera, Arthur and Kifle, Fitsum and Mengistu, Degsew Dersso and Firissa, Yared Boru and Gemechu, Tirunesh Busha and Dausab, Gaudencia and Kauta, Unotjari and Sikuvi, Kaveto and Kechiche, Nahla and Ki, Kélan Bertille and Mukenga, Martin and Munlemvo, Dolly Matondo and Bittaye, Mustapha and Jagne, Abubacarr and Omar, Mohamed Abdinor and Ali Daoud, Hassan and Faisal, Mohamed and Elfiky, Mahmoud and Seleke, Mpho and Fadalla, Tarig and Koko, Alshaima and Bedada, Alemayehu and Outsouta, Gilles Niengo and Elombila, Marie and El Adib, Ahmed Rhassane and Essafti, Meryem and Lopes, Dino and Morais, Atilio and Ndarukwa, Pisirai and Handireketi, Newten and Bulamba, Fred and Mrara, Busisiwe and Kluyts, Hyla and Kinnes, Marian and Hashi, Abdullahi Said and Amponsah, Abigail Kusi and Akinpelu, Aderonke Omobonike and Amata, Andrew and Peter, Aunel Mallier and Nwasor, Elizabeth and Kalambayi, Geremie and Kariuki, Hellen N. and Fening, Nana and Moyo, Nomaqhawe and Mukuna, Patrick and Chetty, Sean and Bechan, Sudarshanie and Pretorius, Tania and Owoyele, Victor Bamidele and Mqadi, Luyanduthando and Duvenage, Hanel and Arendse, Gwendoline and Hannan, Luke and Myer, Landon and Schell, Carl Otto and Baker, Tim and Pearse, Rupert M. and Biccard, Bruce, Severe Pain is Associated with Critical Illness and Mortality in Hospitalised Patients Across Africa: A Point Prevalence Study of 22 African Nations. Available at SSRN: https://ssrn.com/abstract=5217959 or http://dx.doi.org/10.2139/ssrn.5217959
Download This Paper